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Drug and Alcohol Detoxification: Withdrawal Symptoms and Detox Process

Many people begin substance use disorder (SUD) treatment with a period of detoxification and withdrawal management. As an important element of early recovery, drug and alcohol detox can provide supportive care and access to medical interventions, when needed. Supervised detox can help keep people safe and comfortable during withdrawal as their bodies clear themselves of the influence of drugs and/or alcohol.1

This article may be helpful as you compare detox centers and choose to take the brave step toward recovery.

What Is Detox?

A medical detox setting allows doctors and other treatment professionals to closely monitor people while providing specific medications, if needed, to manage withdrawal.2 Treatment medications for withdrawal are not available for withdrawal from all substances. Undergoing supervised medical detox under the guidance of professionals can help keep you safe and prevent serious, even life-threatening complications during drug and alcohol detox and withdrawal.1

Some people may think of detoxification and substance use treatment as the same thing, but detox is not the same as treatment or rehab. Though it is a very important element of treatment, detox from drugs and alcohol is typically the first part of a longer treatment process for people with substance use disorders.2

Alcohol and Drug Detox Process

Though individual experiences may vary somewhat, there are three fundamental elements of many alcohol and drug detox programs. These elements include:3

  • Evaluation, or a period during which you will undergo a full assessment to best determine your full range of medical, psychological, social, or other specific detox and treatment needs.
  • Stabilization, which involves supportive care and, when necessary, medical interventions to help people manage the acute withdrawal period. The stabilization period also provides a good opportunity for programs to help you understand the upcoming addiction treatment
  • Fostering patient readiness for treatment, which may involve setting up ongoing substance use treatment and emphasizing the importance of continued treatment after the detox period. In addition, counselors work to increase your treatment engagement, motivate you to continue treatment, and may even develop a written contract for you to attend ongoing treatment.

Withdrawal Symptoms During Alcohol and Drug Detox

Certain types of substances, when regularly used, are associated with the development of physiological dependence. This is the process of the body adapting to the consistent presence of drugs and/or alcohol. If you become dependent on alcohol or certain other drugs, you are likely to experience some symptoms of withdrawal when you stop using them.3

The character and severity of these symptoms will vary depending on the substance involved and the degree of dependence present. With certain substances, including opioids and alcohol, detox medications can be used to help manage the symptoms of withdrawal.2

Some general substance-specific withdrawal syndromes may include:

  • Opioid withdrawal. It may cause body aches, fever, sweating, chills, goosebumps, and gastrointestinal distress (i.e., nausea, vomiting, diarrhea).3
  • Alcohol withdrawal symptoms. It may include tremors, irritability, and insomnia. Alcohol withdrawal can have more severe symptoms including hallucinations, extreme confusion, and seizures.3
  • Withdrawal from benzodiazepines. It can be like withdrawal from alcohol. Many individuals withdrawing from benzodiazepines will experience acute anxiety, in addition to agitation and insomnia, and they may experience hallucinations or seizures.3
  • Stimulant withdrawal. It’s typically less physically challenging than some of the other withdrawal syndromes mentioned here; however, it can result in fatigue, depression, agitation, slowed body movements, and cravings for stimulants.3

Who Should Go to Detox?

A professional drug or alcohol detox program and, in particular, medical detox, may be the preferred route of care for individuals at risk of experiencing certain types of withdrawal. For instance, for reasons of safety and avoidance of needless discomfort, medical detox may be the most appropriate setting for people experiencing acute alcohol, sedative-hypnotic, and/or opioid withdrawal syndromes.3

Assessing your need for a detox from alcohol and drugs, including the level of intensity of care and the specific treatment setting in which it may most safely take place, is often done best after a thorough assessment by a treatment professional. The American Society for Addiction Medicine (ASAM) offers placement criteria as guidelines for professionals to assess multiple areas and determine the best course of detox and treatment for each individual seeking treatment help.

Such a multi-dimensional assessment takes into consideration:4

  • Acute intoxication and withdrawal potential.
  • Medical conditions and complications that might require treatment attention.
  • Emotional, behavioral, or cognitive conditions that could influence the course of treatment.
  • An individual’s readiness to change.
  • A person’s potential for relapse, continued use, or other continued problems.
  • The recovery/living environment of the person seeking recovery help.

How Long Does Drug and Alcohol Detox Take?

From start to completion, the total length of alcohol and drug detox will vary for everyone. Numerous factors are involved including the type of substance being used, how severe the person’s dependence is, their overall health, and how much they used the substance or for how long.

Estimated timelines for withdrawal from certain substances are as follows:

  • Alcohol: For many people, symptoms of alcohol withdrawal may begin as early as a few hours after the last drink and peak in intensity between 24 to 48 hours later. Seizures and other signs of over-excitation in brain activity may manifest within 12 hours to 2 days after the last drink; more rarely, some people remain susceptible to severe alcohol withdrawal delirium (also known as delirium tremens, or DTs), for as long as 3 days after the last use of alcohol.10
  • Benzodiazepines: These are associated with an acute withdrawal syndrome that may first develop within several hours to days after a person quits using relatively shorter-acting benzos (such as Xanax and Ativan), and last as long as one week for relatively longer-acting medications (such as Valium).5 Benzodiazepine withdrawal symptoms can remain troublesome for several days to weeks before resolving.
  • Opioids: Withdrawal can vary based on the duration of action of the involved opioid drugs. Short-acting opioids, such as heroin, are often associated with an onset of withdrawal symptoms around 6 to 12 hours after the last use which may last for anywhere from 5 to 7 days.5 Dependence on longer-acting opioids more commonly results in withdrawal symptoms at 2 to 4 days after the last use, with the total duration of withdrawal being 10 to 20 days.3, 5

What Are the Dangers of Detoxing Alone or at Home?

When people compare detox centers and detox options, they may wonder how to detox from drugs alone at home or consider rapid detox centers but there could be greater risks for complications in trying to detox without proper medical oversight or access to potential life-saving interventions. Detoxing alone may be particularly risky when a person is withdrawing from alcohol or benzodiazepines since people can sometimes develop seizures or even die from withdrawal.3

In addition, while opioid withdrawal is not usually dangerous, it is still possible to become very ill during withdrawal. As a result, the need for medical attention may be present for issues like electrolyte disturbances caused by acute gastrointestinal distress.3 Another danger in trying to safely detox from opioids at home is the potential for relapse, as acute opioid withdrawal can be severely unpleasant, prompting some to quickly start using drugs again to stop the withdrawal symptoms.6

How Is Alcohol and Drug Detox Medicine Used?

Medication may be used for certain types of withdrawal management. The most common practice for managing alcohol withdrawal is the use of a relatively long-acting benzodiazepine to minimize symptoms such as agitation and decrease the risk of seizures. Phenobarbital or other anticonvulsant drugs are sometimes used for this purpose as well.

For opioids, several medications may be used to manage some of the difficult symptoms of withdrawal. Detox medicine options include:3

  • Methadone, an opioid agonist medication that helps manage withdrawal symptoms and decrease cravings for opioids.
  • Buprenorphine, a partial opioid agonist medication that—similarly to methadone—interacts with the opioid receptors in the brain to control withdrawal symptoms and manage cravings to use opioids.
  • Clonidine, a non-opioid medication that can relieve some of the symptoms of opioid withdrawal.
  • Lofexidine—with a similar mechanism of action to clonidine—a relatively recently approved medication used to manage some symptoms of opioid withdrawal.7

Where Does Alcohol and Drug Detox Take Place?

People who are struggling with an addiction may be wondering if there is ‘emergency detox near me,’ or what type of detox to choose. Though detox approaches vary from one program to the next, many broadly follow either a social or medical detox framework:3

  • Social detox relies more heavily on interpersonal support as individuals navigate withdrawal and early recovery. These programs have historically been short-term, nonmedical, and may not provide medications for withdrawal management. Access to medical and nursing services under a social detox model may be highly variable.
  • Medically assisted withdrawal programs may use medications for managing withdrawal from substances such as alcohol and opioids and provide more supervision. Such programs may better facilitate an escalation of care in the event of withdrawal complications or when the need for more intensive services otherwise arises.

Different detox programs may operate in either inpatient or outpatient settings.3, 4

  • Inpatient treatment settings offer 24/7 oversight and support. Inpatient treatment with detox is an appropriate level of care for people at risk of severe/complicated withdrawal, who have underlying mental health issues, or who have physical illnesses that may need attention during withdrawal. Some inpatient programs are inside hospitals, but others are in freestanding facilities.
  • Residential detox programs vary a great deal from one another in terms of how much supervision and oversight people receive while there. Some of these residential detox programs may emphasize social detox rather than using medications to manage withdrawal.
  • Outpatient programs may provide an appropriate level of care for people experiencing mild to moderate withdrawal symptoms. Some programs are classified as intensive outpatient programs (IOP), in which the participants meet for at least 9 hours each week, usually 3 hours at a time, 3 days per week. Others offer partial hospitalization programs (PHP), which meet for 20 hours each week. These types of outpatient programs offer the same types of assessments, supervision, and interventions as inpatient programs, but allow people to go home at night and sometimes keep going to work or school while getting treatment.
  • Ambulatory detox is an appropriate option for certain people and circumstances and involves regular visits to a doctor’s office or clinic for monitoring during detoxification treatment.

What Happens After Detox for Drugs and Alcohol?

Professional detox services should not be viewed as a substitute for more comprehensive rehabilitation. Detox from drugs or alcohol is only the first stage of treatment and long-term recovery from substance use disorders.1 Ongoing rehabilitation typically involves behavioral therapy as a cornerstone of treatment. For people recovering from alcohol use disorders and opioid use disorders, medications in conjunction with therapy may be an important component of treatment.1,

A handful of Food and Drug Administration-approved (FDA) medications can help people manage cravings for opioids and facilitate long-term recovery from opioid use disorder. These medications are:3

  • Buprenorphine, a maintenance medication that can be used to help people in recovery continue to manage their cravings for opioids without feeling the euphoria associated with opioid use.
  • Suboxone, which is buprenorphine combined with an opioid antagonist drug called naloxone. This formulation was created to deter misuse of the treatment medication itself.
  • Methadone, which, like buprenorphine, can be used as a maintenance medication for those recovering from opioid use disorders.
  • Naltrexone, an opioid antagonist medication that blocks the reinforcing effects of opioids and, in doing so, may decrease the likelihood of continued opioid misuse. Naltrexone is not used during the detox/withdrawal management phase as it could worsen or precipitate withdrawal.8

For those who have an alcohol use disorder, the FDA also has approved medications that can help people avoid relapse and maintain longer periods of recovery.9

  • Antabuse, also known as disulfiram, can deter alcohol use by causing a highly unpleasant reaction if the person drinks while taking the medication.
  • Campral, which is the brand name for acamprosate, is medication that can help people maintain sobriety by reducing some of the more protracted symptoms of alcohol abstinence.
  • Naltrexone, the same opioid-antagonizing medication that blocks reinforcing effects in the treatment of opioid use disorder, also decreases the rewards of drinking. Consequently, if a person is on naltrexone and then drinks, they will not experience the full reinforcing effects of alcohol—helping to decrease the likelihood of drinking alcohol in the future.

In addition to the use of medication for some substance use disorders, ongoing treatment beyond detox is important to promote more positive recovery outcomes.1 Several approaches to behavioral therapy are commonly used in treatment programs, including cognitive behavioral therapy and contingency management.

Does Insurance Cover Drug and Alcohol Detox?

If you have insurance, your plan may provide full or partial coverage for drug and alcohol detox. The Affordable Care Act (ACA) recognizes substance use disorder treatment as an essential healthcare benefit for U.S. citizens. This means that per the ACA, insurance companies must provide coverage for substance use disorder treatment in some capacity. Your coverage will depend on your specific plan.11 If you don’t have coverage, there are still ways you can pay for detox without insurance. Grants, loans, payment plans, and sliding scales are just a few options to pay for detox that you can research.

If you have questions about using insurance for detox or rehab, American Addiction Centers (AAC) can help. Contact us by 24 hours a day, 7 days a week, or verify your insurance now and reach out for more information later.

How to Find Local Detox

If you’re ready to take the next step, American Addiction Centers (AAC) can help you find local detox centers. With facilities across the country, AAC offers various levels of evidence-based care to suit your needs. Contact us by 24 hours a day, 7 days a week to speak with a compassionate admissions navigator. They are here to answer your questions, discuss detox treatment options, and help you begin the admissions process once you’re ready. You can also use our directory to find detox treatment programs near you.

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